Spatial aspects of MRSA epidemiology:A case study using stochastic simulation, kernel estimation and SaTScan

The identification of disease clusters in space or space-time is of vital importance for public health policy and action. In the case of methicillin-resistant Staphylococcus aureus (MRSA), it is particularly important to distinguish between community and health care-associated infections, and to identify reservoirs of infection. 832 cases of MRSA in the West Midlands (UK) were tested for clustering and evidence of community transmission, after being geo-located to the centroids of UK unit postcodes (postal areas roughly equivalent to Zip+4 zip code areas). An age-stratified analysis was also carried out at the coarser spatial resolution of UK Census Output Areas. Stochastic simulation and kernel density estimation were combined to identify significant local clusters of MRSA (p<0.025), which were supported by SaTScan spatial and spatio-temporal scan. In order to investigate local sampling effort, a spatial 'random labelling' approach was used, with MRSA as cases and MSSA (methicillin-sensitive S. aureus) as controls. Heavy sampling in general was a response to MRSA outbreaks, which in turn appeared to be associated with medical care environments. The significance of clusters identified by kernel estimation was independently supported by information on the locations and client groups of nursing homes, and by preliminary molecular typing of isolates. In the absence of occupational/ lifestyle data on patients, the assumption was made that an individual's location and consequent risk is adequately represented by their residential postcode. The problems of this assumption are discussed, with recommendations for future data collection.

B2B service brand identity and brand performance:an empirical investigation in the UK’s B2B IT services sector

Purpose – This paper aims to apply the business-to-business (B2B) Service Brand Identity (SBI) scale to empirically assess the influence of service brand identity on brand performance for the first time. Design/methodology/approach – Based on data collected from 421 senior marketing executives, this paper applies the B2B SBI and structural equation modeling to fulfill the above purpose. Findings – Brand personality and human resource initiatives have a positive and significant influence on brand performance. Corporate visual identity, in addition to an employee and client focus, has an insignificant impact on performance. Consistent communications have a negative and significant influence on brand performance. Research limitations/implications – Data were only collected from executives in the UK. This research would benefit from replicative studies. Practical implications – This research empirically establishes the brand management activities that drive brand performance. Originality/value – This is the first empirical study to assess the influence service brand identity has on brand performance.

B2B service brand identity:scale development and validation

Several brand identity frameworks have been published in the B2C and the B2B brand marketing literature. A reliable, valid and parsimonious service brand identity scale that empirically establishes the construct's dimensionality in a B2B market has yet to be developed. This paper reports the findings of a study conducted amongst 421 senior executives working in the UK IT Service sector to develop and validate a B2B Service Brand Identity Scale. Following established scale development procedures support is provided for a B2B Service Brand Identity Scale comprising five dimensions; employee and client focus, visual identity, brand personality, consistent communications and human resource initiatives. Concluding remarks discuss theoretical and managerial implications with limitations and directions for future research. © 2011 Elsevier Inc.

Action research in a collective organisation:Developing an education programme in a pressure group

The aim of this project was to develop the education work of an environmental pressure group. The research devised and implemented a project to produce multi-media teaching packs on the urban environment. Whilst this involved understanding environmental education it was necessary to research beyond this to include the various structural and dynamic constraints on change in the field. This presented a number of methodological difficulties; from the resolution of which a model of the research process involved in this project has been developed. It is argued that research oriented towards practical change requires the insights of an experienced practitioner to be combined with the rigours of controlled systematic enquiry. Together these function as a model-building process encompassing intuition, induction and deduction. Model testing is carried out through repeated intervention in the field; thus an interplay between researcher and client ensues such that the project develops in a mutually acceptable direction. In practice, this development will be both unpredictable and erratic. Although the conclusions reached here are based on a single case study they address general methodological issues likely to be encountered in different field settings concerned with different practical problems.

Dynamic client portfolios as sources of ambidexterity:exploration and exploitation within and across client relationships

This paper explains how dynamic client portfolios can be a source of ambidexterity (i.e., exploration and exploitation) for knowledge-intensive firms (KIFs). Drawing from a unique qualitative dataset of firms in the global reinsurance market, we show how different types of client relationships underpin a dynamic client portfolio and become a source of ambidexterity for a KIF. We develop a process model to show how KIFs attain knowledge by segmenting their client portfolios, use that knowledge to explore and exploit within and across their client relationships, and dynamically adjust their client portfolios over time. Our study contributes to the literature on external sources of ambidexterity and dynamic management of client knowledge within KIFs.

Audit fees, non-audit fees and auditor going-concern reporting decisions in the United Kingdom

The accounting profession has come under increased scrutiny over recent years about the growing number of non-audit fees received from audit clients and the possible negative impact of such fees on auditor independence. The argument advanced is that providing substantial amounts of non-audit services to clients may make it more likely that auditors concede to the wishes of the client management when difficult judgments are made. Such concerns are particularly salient in the case of reporting decisions related to going-concern uncertainties for financially stressed clients. This study empirically examines audit reports provided to financially stressed companies in the United Kingdom and the magnitude of audit and non-audit service fees paid to the company’s auditors. We find that the magnitude of both audit fees and non-audit fees are significantly associated with the issuance of a going-concern modified audit opinion. In particular, financially stressed companies with high audit fees are more likely to receive a going-concern modified audit opinion, whereas companies with high non-audit fees are less likely to receive a goingconcern modified audit opinion. Additional analyses indicate that the results are generally robust across alternative model and variable specifications. Overall, evidence supports the contention that high non-audit fees have a detrimental effect on going-concern reporting judgments for financially stressed U.K. companies.

Auditor's engagement risk and audit fees:the role of the audit firm alumni

This study explores the effect of the association of audit firm alumni with their alma mater on audit prices. The tests indicate that there is a moderate reduction of up to 21% in the level of audit fee when alumni (i.e., former employees) of the incumbent audit firm sit on the client board of directors which is consistent with the engagement risk theory. This suggests that there is an 'alumni effect' in the market for audit services. The findings hold only in the large company segment of the market. The results are robust to different model specifications and alternative samples. The sample comprises all executive and non-executive directors who run the UK quoted companies and are simultaneously ICAEW qualified chartered accountants. The study's implications for the accounting profession and the regulators are also discussed. © 2007 The Author Journal compilation © 2007 Blackwell Publishing Ltd.

External audit in the National Health Service in England and Wales:a study of an oversight body's control of auditor remuneration

In the National Health Service (NHS) in England and Wales an oversight body, the Audit Commission (AC), defines the scope of the external auditors’ work, appoints the auditors and has oversight of their fees and audit quality. This heavily regulated audit regime mitigates some of the deficiencies observed in high profile corporate failures. Independence, it has been argued, is influenced by the total auditor remuneration paid by the client. In this study we examine total auditor remuneration in a regulated market which seeks to ensure audit independence and audit quality. In particular we undertake rigorous analysis of auditor remuneration by the type of auditor: We place emphasis on the differentiation between private sector firms and the AC’s in-house auditors (District Audit). Individual private audit firms charge premiums (up to 16%) for particular audit work in identified locations, but no premiums were found when we examined total auditor remuneration. The regime appears to permit efficient operation of the audit market while safeguarding both audit independence and standards.

Marital counselling: follow-up study of marriage guidance clients: perceptions of the agency, the process and outcomes. Available in 2 volumes.

This study is a consumer-survey conducted with former Marriage Guidance Council clients. The objectives were to identify and examine why they chose the agency, what their expectations and experiences were of marital counselling and whether anything was achieved. The material was derived from tape recorded interviews with 51 former M.G. clients (17 men and 34 women) from 42 marriages and with 21 counsellors; data from written material and a card-sort completed by the research sample; and the case record sheets of the research population (174 cases). The results from the written data of clients showed that 49% were satisfied with counselling, 25.5% were satisfied in some ways but not in others, and 25.5% were dissatisfied. Forty-six percent rated they had benefited from counselling, either a great deal or to some degree, 4% were neutral and 50% recorded they had not benefited. However the counsellors' assessments were more optimistic. It was also ascertained that 50% of the research sample eventually separated or divorced subsequent to counselling. A cross-check revealed that the majority who rated they were satisfied with counselling were those who remained married, whilst dissatisfied clients were the ones who unwillingly separated or divorced. The study then describes, discusses and assesses the experiences of clients in the light of these findings on a number of dimensions. From this it was possible to construct a summary profile of a "successful" client describing the features which would contribute to "success". Two key themes emerged from the data. (1) the discrepancy between clients expectations and the counselling offered, which included mis­ match over the aims and methods of counselling, and problem definition; and (2) the importance of the client/counsellor relationship. The various implications for the agency are then discussed which include recommendations on policy, the training of counsellors and further research.

Controlled study into the effectiveness of individual client-centred counselling for young offenders in residential care

This study is toe first documented account in the British Isles of an evaluation of the effectiveness of client-centred counselling with young offenders in secure residential care. It is a test of Rogers' (1957) position on the 'necessary and sufficient' conditions of therapeutic personality change within a counselling relationship. Forty teenage male offenders, the subjects of Training School Orders, were randomly allocated in equal numbers to either an experimental or control group. Boys in the experimental group received weekly individual sessions of client-centred counselling over a seven month period. Boys in the control group received no formal counselling but were shown to have similar intellectual, personality, socio-economic and criminal backgrounds to those in the experimental group. It was hypothesised that counselled subjects would show more positive outcomes than control subjects over a range of measures relating to criminal behaviour and self-conception. The results indicated that the counselled subjects had a significantly lower rate of offending and a srnaller range of offences over a mean follow-up period of 2.5 years. They were also licensed from the institution significantly earlier and spent less time in custody during a one year follow-up after counselling was completed. Self-conception measures gave less clear-cut results. The direction of change towards better adjustment favoured the counselled subjects but the magnitude was often small. Those counselled subjects with most positive behaviour change tended to have significantly improved self-evaluation, less self/ideal self discrepancy and more variation on 'actual' self concept compared to pre-counselling. The results are discussed in the context of client-centred theory, methodological adequacy of the experimental design, and their application to the future treatment of young offenders in secure residential care.

Metrics and models to support the development of hybrid information systems

The research described here concerns the development of metrics and models to support the development of hybrid (conventional/knowledge based) integrated systems. The thesis argues from the point that, although it is well known that estimating the cost, duration and quality of information systems is a difficult task, it is far from clear what sorts of tools and techniques would adequately support a project manager in the estimation of these properties. A literature review shows that metrics (measurements) and estimating tools have been developed for conventional systems since the 1960s while there has been very little research on metrics for knowledge based systems (KBSs). Furthermore, although there are a number of theoretical problems with many of the `classic' metrics developed for conventional systems, it also appears that the tools which such metrics can be used to develop are not widely used by project managers. A survey was carried out of large UK companies which confirmed this continuing state of affairs. Before any useful tools could be developed, therefore, it was important to find out why project managers were not using these tools already. By characterising those companies that use software cost estimating (SCE) tools against those which could but do not, it was possible to recognise the involvement of the client/customer in the process of estimation. Pursuing this point, a model of the early estimating and planning stages (the EEPS model) was developed to test exactly where estimating takes place. The EEPS model suggests that estimating could take place either before a fully-developed plan has been produced, or while this plan is being produced. If it were the former, then SCE tools would be particularly useful since there is very little other data available from which to produce an estimate. A second survey, however, indicated that project managers see estimating as being essentially the latter at which point project management tools are available to support the process. It would seem, therefore, that SCE tools are not being used because project management tools are being used instead. The issue here is not with the method of developing an estimating model or tool, but; in the way in which "an estimate" is intimately tied to an understanding of what tasks are being planned. Current SCE tools are perceived by project managers as targetting the wrong point of estimation, A model (called TABATHA) is then presented which describes how an estimating tool based on an analysis of tasks would thus fit into the planning stage. The issue of whether metrics can be usefully developed for hybrid systems (which also contain KBS components) is tested by extending a number of "classic" program size and structure metrics to a KBS language, Prolog. Measurements of lines of code, Halstead's operators/operands, McCabe's cyclomatic complexity, Henry & Kafura's data flow fan-in/out and post-release reported errors were taken for a set of 80 commercially-developed LPA Prolog programs: By re~defining the metric counts for Prolog it was found that estimates of program size and error-proneness comparable to the best conventional studies are possible. This suggests that metrics can be usefully applied to KBS languages, such as Prolog and thus, the development of metncs and models to support the development of hybrid information systems is both feasible and useful.